Barriers and facilitators to hepatitis C screening and treatment for people with lived experience of homelessness: A mixed‐methods systematic review

Abstract

Background: People experiencing homelessness have an increased risk of hepatitis C virus (HCV) infection, with rates higher than the general population. However, their access to HCV diagnosis is limited and treatment uptake is low.Objectives: To identify and describe the barriers and facilitators for HCV screening and treatment for adults with lived experience of homelessness in highly developed countries. Methods: Bibliographic databases (Embase, MEDLINE, CINAHL and SocINDEX) and grey literature (Google, EThOS, the Health Foundation, Social Care Online, the World Health Organisation, Shelter, Crisis and Pathway) were searched. Two reviewers independently screened and appraised all studies. The Critical Appraisal Skills Programme tool and the Joanna Briggs Institute checklist were used. The analysis involved a three-stage process: coding, theme generation and theme mapping under Penchansky and Thomas's modified access model. Results: Twelve papers/reports were included in the review. Several interacting factors influence access of people with lived experience of homelessness to HCV testing and treatment. Some mirror those identified for the general population. The precarious conditions associated with the lived experience of homelessness along with the rigidity of hospital settings and lack of awareness emerged as dominant barriers. Flexibility, outreach, effective communication, tailoring and integration of

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

“…There are multiple mechanisms by which homelessness might impact treatment uptake including providers considering homelessness a sign of “unmanageability” [ 5 ], and people considering treatment initiation as less urgent than other, competing priorities [ 24 , 25 ]. Although opioid agonist treatment services and NSPs do not require people to be housed to access services, people experiencing homelessness may still face increased structural barriers to access [ 26 ]. Stable housing reduces the risk of HCV transmission [ 27 ] and removes stressors to allow people to prioritise health and wellbeing [ 28 ].…”

“…Stable housing reduces the risk of HCV transmission [ 27 ] and removes stressors to allow people to prioritise health and wellbeing [ 28 ]. Some interventions have attempted to mitigate the effects of homelessness with regards to treatment uptake, by providing flexible appointments [ 26 ] or mobile testing and treatment [ 29 ]. A mobile unit employing a same day ‘test and treat’ model for a cohort in which the majority were experiencing homelessness, reported 77% initiating treatment [ 30 ].…”

Disrupting patterns of exclusion in participatory spaces: Involving people from vulnerable populations

“…First, we consider who is in spaces for sharing decisions about research, services and policy in this special issue. There are papers with lead authors from seven countries: the United Kingdom, [22][23][24][25][26][27][28] Australia, [29][30][31][32][33] Canada, [34][35][36][37][38] the United States, 39,40 the Netherlands, 41,42 France 43 and Ecuador. 44 There are important examples involving people who experience homelessness, 22,23,34 people who have disabilities, 26,41,42 people who live in socioeconomically disadvantaged circumstances 35,37 and people who are migrants and/or from ethnic minority groups.…”

“…There are papers with lead authors from seven countries: the United Kingdom, [22][23][24][25][26][27][28] Australia, [29][30][31][32][33] Canada, [34][35][36][37][38] the United States, 39,40 the Netherlands, 41,42 France 43 and Ecuador. 44 There are important examples involving people who experience homelessness, 22,23,34 people who have disabilities, 26,41,42 people who live in socioeconomically disadvantaged circumstances 35,37 and people who are migrants and/or from ethnic minority groups. 25,31,36 There are also papers involving people with diabetes who experience stigma because of their condition 30 and COVID vulnerable populations, such as those with genetic, undiagnosed and rare disorders.…”

“…Second, what kind of methods are used in projects based on these partnerships? The papers report systematic reviews, [23][24][25] original research using qualitative, quantitative and mixed-methods studies 26,[29][30][31][34][35][36][37][39][40][41][42] and reflective practice. 22 This resonates with a key finding in the wider literature about meaningful partnerships 3,4 : collaborative research orientation is the core issue rather than the nature of the methods being used.…”